Understanding the Disruptive Potential of MDT in Metastatic Prostate Cancer Treatment, Exploring Hypotheses for Future Studies

[Mascouche]

Interesting article from Jan 29 2025 which covers topics such as:

* MDT to Delay ADT in Metachronous Metastatic Hormone-Sensitive Prostate Cancer (SBRT in Monotherapy)

* MDT Combined With Short Intermittent ADT in Metachronous HSPC (Short, Combined Treatment)

* MDT to Delay New Systemic Therapy in Oligoprogressive Castration-Resistant Prostate Cancer (SBRT Added to Systemic Therapy in Advanced Cancer)

* MDT as Part of Total Therapy for De Novo Low-Volume HSPC (Total Therapy; Intensifying but Shortening)

* MDT as a Last-Line Option in Polymetastatic Disease (SBRT to Polymetastases)

Key Points:

* Lifelong androgen deprivation therapy (ADT) has been the cornerstone of metastatic prostate cancer treatment but is associated with significant side effects; new therapeutic agents have improved progression-free survival (PFS) and overall survival (OS), driving more intensive systemic regimens.

* Stereotactic body radiotherapy (SBRT)-based metastasis-directed therapy (MDT) shows promise in both therapeutic escalation (e.g., targeting the prostate and all metastatic sites) and de-escalation (e.g., MDT as monotherapy), with phase 2 trials demonstrating benefits such as delayed systemic therapy, reduced toxicity, and improved outcomes.

* Large-scale trials are needed to validate MDT’s role, refine strategies, optimize therapy duration, and identify biomarkers for personalized treatment approaches.

For the full article: dailynews.ascopubs.org/do/u...

[Schwah]

Very interesting article. This tracks closely with what my own MO has been telling me. In his practice (over 3,000 PC patients) he has found SBRT to be a very effective mono treatment for men who do not want to go back on hormone blockers or used as part of an intermittent ADP therapy. The key factor he says, is the advent of the PSMA scan. This highly accurate scan allows for great confidence that all significant mets are found and ablated. It is also possible that an abscopal affect is at play here but no proof of that as yet.

I am approaching three years off all meds since my second SBRT treatment. I do PSMA scans s about twice a year.

I am particularly interested to hear the TAs take on MDT with SBRT after reading that article and the studies cited. Have great respect for his opinions and I don’t think he was convinced yet that it prolonged life as either a mono therapy or combined with IADT. Perhaps his thinking has changed?

Schwah